10 Reasons Not To Not Hire A Doula

I read a blog entry recently about doulas called “10 Reasons to not hire a doula”.  It was, according to the author, meant to be a parody.  As a doula I found none of it funny.  And actually was annoyed by its perpetuation of the doula stereotype.  So I decided to write a rebuttal.  I’ll try for humour as best I can and I hope to not anger anyone in the process of examining the “10 Reasons not to not hire a doula”.

Point one, Expense.  Yes Doulas are an out of pocket expense for most people.  And as the writer of the blog was American who probably has to pay medical expenses to have a baby I can see where this would be an issue.  In Canada we spend our money on the acres and acres of crap you don’t need when you have a baby.  Thousands of dollars in nursery furniture and décor in a room your child won’t even use for the first 6 months of their life, clothes from Old Navy and Baby Gap that your infant will enjoy spitting up on and pooping in.  Have you experienced the explosive poop? You better hope it isn’t in the $40 Gap onsie, cause no amount of Oxyclean will get that stain out.  And what about the $50 Nike baby running shoes? You squeeze them onto your baby’s potato shaped feet and if you’re lucky you won’t lose one in the mall, never to be seen again. 

Perhaps saving some of that money to spend on the day of your birth might be money better spent.  When you are 90 years old and you can’t remember what you had for breakfast that day, you will be able to recall your birth.  You probably won’t be giving birth 20 times like Michelle Duggar so why not make the experience as calm and stress free as possible.  Having a doula helps you be involved in the birth, have your questions answered and makes you feel a part of the birth and not that the birth just happened to you.  Also for the dads, we make you guys look like rock stars.  We show you how to help and let you be as involved as you want to be, at your own comfort level. 

And if the expense is still too much for you, many doulas work on a sliding scale or you could get a doula-in-training who may work for expenses or free. 

Point two, apparently all women just want to get the baby out as fast as possible. Funny, this is the precise reason to hire a doula.  Studies have shown that having a doula has been instrumental in shortening the length of labour and decreasing the severity of the discomfort felt.  I really don’t think I need to say more on this one. 

Point three, “A doula may try to talk you out of having drugs.” That is crazy.  I’ve had two epidurals and they are wonderful things.  I’ve also done it without drugs.  I would never talk a momma out of having an epidural unless her baby was sitting on her perineum.  This is not the doula’s birth.  Its the momma’s birth and if she wants drugs, no problem.  Hook her up.  If she doesn’t, I can get her to the end.  If she wants to try to go as long as possible without, I’m there.  Whatever momma wants, momma gets.

Point four, if the doula becomes a peppy cheerleader, the author will punch her.  Well so would I.  You hire a doula that fits with our personality.  If you are dragging and the end is overwhelming you we can be peppy if that’s your style, we can be strong and tough, we can be the shoulder to cry on, we can give you hints and tips to get you over that hump.  So I encourage you to interview several doulas to make sure you find the right doula for you, one that fits with your personality.

Point five, Doulas do not offer the doctor help.  We are not medical.  We assist in comfort measure suggestions, tidying the room, helping mum shift position, getting cold cloths and ice chips, supporting mum’s leg during pushing, watching dad so he doesn’t faint, but never suggestions on momma’s medical care.  That’s just crazy.  Doulas help parents make decisions by ensuring they have all the information and in order to do that we read lots of studies, on the internet.  But we help parents navigate the crap that can be found on the internet so what they know is evidence based and up-to-date.  Though I’ll admit, there is the odd doctor I’d love to see have a head explosion, that is out of my scope of practice.   And I’ll address the “hippie” comment in point nine.

Point six, I agree you shouldn’t have dozens of people in the labour room.  But the people you have shouldn’t be spectators either.  The people you invite to your birth should be helpful and encouraging and supportive of your choices.  That may not be your mother-in-law or you teenage sister.  Birth is not a spectators sport.  It’s an intimate experience that you will remember for the rest of your life.  So choose wisely.  And as for the oblivion mommas used to experience and get their babies three days later?  Well in my opinion, that’s what’s wrong with the world today.  We are a messed up society because we messed up birth for so many generations.  I’ll jump off my soap box here as I could go on a tangent.

Point seven, Breastfeeding. Yes we help with breastfeeding.  If you don’t want to breastfeed that’s your choice.  Doulas support choice.  Many mommas though want to breastfeed and it isn’t easy.  The most successful breastfeeding mommas are those that have support at home and can have their questions answered and latches checked.  But if you don’t want to breastfeed, doulas can help in giving advice on safe formula feeding. 

Point eight, lady bits? Really? I can’t even come up with a decent response to that one. 

Point nine, Crunchy granola hippie doulas.  Let’s see, I shave my legs and arm pits, wear make-up, dye my hair and get my nails done every two weeks.  I recycle and compost because my city requires me to, not because I want to and my car is far from eco-friendly.  As doulas go, I’m lumpy oatmeal at best.  I don’t say Yoni. I say Vagina, because that’s what it is.  I don’t chant or wear flowy skirts and beads.  I wear high heeled shoes not Birkenstocks.  I have never been a hippie and would never be accused of being one.  This point is the one that irritated me the most.  I don’t have a problem with my doula sisters who are crunchy, they are beautiful women.  But that’s not who I am. 

Point ten, the best point. Postpartum Doulas are awesome and very helpful in assisting new moms in the early days and weeks of motherhood.  They help with breastfeeding, making sure mom is getting rest, getting good food, having her house tidied and her questions answered, all without judgment of her choices.

Look, having a doula isn’t for everyone.  But having a stereotyped opinion of a doula and knocking them without really knowing who we are or what we do is just bad form.  So the next time you’re pregnant or the first time, look at what you want for your birth and the experience you will hold for a life time and consider the benefits of hiring a doula to ensure you get the birth you want, whatever it happens to look like. 

Did you know that in most hospitals you are allowed two support people? Presumably one will be your partner and the second can be...your friend, a family member, or a hired professional called a doula.  Having an extra set of hands to assist you and your partner can be very beneficial.  In the case of a doula, The assistance comes without judgement and with an expertise in modern birth and a knowledge of the workings of the hospital.

But what if you were told by your doctor that they didn't allow you to have a doula?  Do you think your doctor has the right to dictate who your support people are? One such incident was highlighted to me earlier this week and it got me thinking. 

Consider this, what are the chances your doctor will actually be at your birth? Having a doula offers you continuity of care.  Your own doctor can't offer you that.  The vast majority only work at their hospital once a week or less.  And as most hospital policies do not dictate the precise "who" you can have, where is it coming from that your doctor can say precisely who will be there to support you?

One reason could be that the doctor has had a past bad experience with a doula and has written off the entire profession.  A situation of one bad apple spoiling the bunch.  But like with all things, there is good and bad.  There are good doulas, and bad doulas.  Just like there are good doctors and bad doctors, good nurses and bad nurses.  But you might agree, that one bad experience shouldn't ruin the experience of all mothers and shouldn't take away a woman's choice for her own birth.  If we did that, then most of us wouldn't be seeing doctors at all, or going to hospitals. 

A second reason might be control.  Some doctors, not all, like to micro manage birth.  They like to control the process and don't like to answer questions.  Some feel the questions you ask are actually you questioning them as a doctor and as a professional.  Some think the doula is whispering in your ear and getting you to make decisions that go against medical advice, or that the doula is bad mouthing them behind their back. 

Nothing could be further from the truth.  A doula is there to support your decisions.  To help you in physical comfort and evidenced based information.  To remind you of your birth plan, that you and your doctor agreed to.  To help you cope when things don't go as planned and to be with you even when everyone's shift has ended.  They are not there to make decisions for you, but to help make sure you have all the information to make an informed consent decision.  And informed consent is your right as a patient. 

So what is a parent to do when confronted with having to choose between the birth team she wants and not upsetting their care provider? The easy answer is nothing.  It shouldn't be a choice.  Your birth should be what you want it to be.  With a care provider you like, who is supportive of your choices, in a place where you feel comfortable, either at home or a hospital or a birth center.  With a team of supporter of your choosing who will care for you, listen to you, and be with you every step of the way. 

But how do you do that? Research.  Interview, yes even doctors.  Go on tours of different facilities, ask questions, ask your friends, family, co-workers, prenatal teacher.  Research on-line, read books beyond What to Expect When Your Expecting.  Pregnancy and birth are all about choice.  Don't have that choice taken away from you because of fear and ignorance. 

Partners.....

What is the role of the partner in the birthing room? For so many generations partners either didn't want to be in the birth room or were barred from being there.  Women were surrounded by their female family members and women in their community.  They were supported with love and compassion and the skill of women who had birth before them.

These days the skill comes from doctors and nurses and midwives.  And the love and compassion comes from their partners.  This can put many partners in an awkward position.  To see the woman you love, in perceived pain, and unable to sympathize or make it go away.  Desperately trying to remember what was said in the prenatal classes, kicking yourself for not reading those pages she had flagged for you and scrambling to find the birth plan she printed off to bring to the hospital.  What is a partner to do when suddenly faced with labour day and being overwhelmed and under prepared?

Step One:  Remain Calm
Even if you are freaking out on the inside, stay strong and in control on the outside.  All that comedic drama we see birthing mothers and their partners pull in the movies is FICTION! She needs your strength even when you aren't feeling it yourself.

Step Two:  Be There
That may seem obvious but I don't mean just physically.  You must be there mentally as well.  So that means no iphone, no blackberry.  Watch her, not the monitors.  Hold her hand, rub her back, listen to her wants and needs and respond to them.  Don't be distracted by the buzzing of your phone with texts and calls from anxious family members.  They can wait.  She needs you now.

Step Three: You are Papa Bear
You are there to protect your family and make sure they are safe.  How do you do that? Ask lots of questions, follow your gut and don't assume every suggestion is right for your family.  Most protocols are based on averages.  And your woman is not average.  She is an individual and her birth is as unique as she is.  She should be treated as such.  Protect her and her space so she can feel safe enough to let go and work at her labour.

Step Four: Plan Ahead
You can't show up for the birth and expect awesome.  No one wakes up one day and decides to run a marathon and win. You have to train or your twitter feed from the finish line will end with #fail.  Listen in prenatal class and practice the comfort measures you are taught.  Most importantly create the birth plan together.  This way you will know what she wants and why and how important each item is to her.  Know what you are fighting for when you are Papa Bear. 

Step Five: Know Your Limitations
Know what you are capable of.  What are your strengths and weaknesses? If you cannot do steps one to four with 100% of your abilities, get help.  Preferably a Doula who will assist you in all your steps and do it so you end up looking like a rock star.  Take all the credit, she won't mind.  Being honest about your ability to assist momma and asking for help is what she needs.  Being macho is not a welcome trait in the labour room, but honesty is.

Answer these questions: Can you be all she needs? Can you handle everything you may face? Do you have the stamina to run this marathon with her? If a voice in your head said no at any point, ask for help.  She'll love you for it in the end. 

My Completely Biased Favourite Places to Give Birth in Toronto

I currently teach prenatal classes at York Central Hospital. Because the program is run by an outside organization I often get couples that are having their babies in other hospitals. I realized the other day that I have an obvious bias toward certain hospitals. So as such, I thought I would try to keep my biases out of the classroom and share them here instead.  

Sunnybrook - Having your baby at Sunnybrook is a definite experience. If I were to have another baby and had to have a hospital birth it would be here. The facilities themselves are practically brand new. Private labour rooms double as your postpartum room and are roomy with most medical equipment actually hidden behind cabinets and stored away. The bathroom holds a wonderful deep tub with jets and room for partner should they choose to join mum in the water. And there is optional dim lighting in there too. And the most practical touch of all, a mini fridge to hold your drinks and food to use during labour and postpartum.

But all that is just window dressing. The staff make your birth experience at Sunnybrook truly fabulous. The nurses, who are your main contact at the hospital, are definitely there for you. Whether you are choosing an unmedicated birth or are looking forward to your epidural, the nurses will be there to assist you in executing your birth plan as best they can. I have rarely seen women pressured in to procedures they don't want to the sake of expediency. They are open and friendly and caring. The doctors as well are a rare breed in the world of maternity care. Several I have seen are open to choice, one was even supportive of a clients desire to have her baby in water. Something we only really see with midwives and homebirths. Whether you are hoping for more then 5mins in your appointment or delaying your cord clamping by 2hrs, there is a doctor at Sunnybrook for you.  

Toronto East General - Until Sunnybrook came on line, Toronto East was my top pick for hospitals in Toronto. Like Sunnybrook the staff is fabulous. The nurses are kind and caring and the pressure to get an epidural is minimal. The facilities themselves while older are still good, with big rooms and tubs in almost every room.

The doctors are also unique in offering breech vaginal delivery and discussing choices with informed consent as opposed to pressuring patients into what will work best for the doctor and their schedule. Toronto East General is also one of only two hospitals in Ontario that have been awarded an official Baby Friendly Hospital by The World Health Organization and Unicef. Not even Sunnybrook has this. As such they also have an amazing breastfeeding clinic to help you in getting the support you need in that critical time after birth when you and your baby are learning to breastfeed.  

Mount Sinai - While many doulas would not even have Mount Sinai on their list at all, I have had too many good experiences not to have them on my list. Mount Sinai is the only hospital where my clients have not ended up in a cesarean section. Almost 30 percent of my clients have birth there and none have had a surgical birth. That's amazing. While the facilities are old and in the process of being updated, the staff are fairly good with staff who are open to natural birth, even if they don't always understand a woman's desire to go natural. I have seen women pressured to accept interventions simply to speed up the process, but if you enter into your labour with a plan in mind, educated on your options and with good support who will advocate for you then you may not fall prey to unnecessary procedures.  

The Others - The rest that round out the list include North York General, of which I have a certain fondness, having been born there myself. Markham-Stouffville, for its recent achievements in reducing their cesarean section rates. And Scarborough Grace where I had my own children with an amazing OB.

So that is my completely biased list of hospitals in Toronto. If your hospital isn't on this list, odds are it isn't one of my favs. But I'm just one doula. Your birth will be what you want it to be and what you allow it to be. But wherever you are having your baby I always recommend a doula to help you get the birth you want.